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  • « Party on the verge of a nervous breakdown | Main | Memo to Democratic activists: you're missing the point, and you're blowing it for Obama »

    September 12, 2008

    HIV: "Remember me?"

    Posted by: Kevin

    Classic_time_bomb_2 The growing raft of statistics is proving what many have been yelling about for years: the HIV/AIDS epidemic in the United States is far from over, but in fact it is gathering strength in the wake of our government's lagging and inefficient response.

    Yesterday, the Centers for Disease Control issued a report that is more detailed than ever about precisely where new infections are happening.  As expected, particularly for local and state AIDS service organizations, the disease continues apace among men who have sex with men, and is disproportionately exploding among blacks and latinos. (The report is here.)

    But between the lines is yet another indication of where the U.S. is falling dangerously behind on a number of policy fronts -- a giant portion of those infected today (between 25% and 28%) don't know they have HIV, and a great number of them will unknowingly infect others and only enter treatment later than they should.  This is horrifying, and it isn't news to any AIDS service organization in major cities or especially the rural South.  Also, as much as 80% of gay and bisexual men in 15 cities have not been reached by HIV prevention efforts that have been proven effective. 

    In short - at a time where no other country is doing more in the global fight against AIDS, America has been slow to react to shifting factors at home, and has abandoned the fight by default.  For the gay community, which spent so much of its blood and treasure, and lost nearly a whole generation in the first half of this epidemic, this should be the most outrageous and galling information to emerge yet in this political year.

    In July of this year, Kai Wright wrote an excellent and incisive piece for The American Prospect which described the creeping "AIDS apartheid" that has unfolded over the past several years.  He shows how it is due to the inertia in shifting our national HIV/AIDS policies to get in front of the changing face of this epidemic.  The American South has become an HIV/AIDS "ground zero" because of outdated, clanking federal policies on routine HIV testing, on funding through the Ryan White CARE Act (that is still far too tied to formulas shaped for the epidemic of 1990), and the gross abdication of effective prevention efforts of any kind where they are needed the most.  And Wright correctly concludes that "(w)hatever is causing the racial disparity in infection rates, it is ultimately going to collapse the system we built to make AIDS care accessible in the United States."

    Wright joins the growing voices in favor of a U.S. national HIV/AIDS strategy.  It is amazing, but we have never had one.  As a pre-requisite of receiving money from President Bush's ground-breaking multi-billion dollar global AIDS program, countries with a tiny fraction of our GDP must have a national HIV/AIDS strategy, with targets and goals spread out over increments of 1-5 years, and must have a national AIDS director that is accountable for them.  And yet, astoundingly, the United States has never done the same.

    Our national response since the advent of the Ryan White CARE Act in 1990 has been a hodge-podge of stop-gaps and fiscal rescuing of state and local authorities.  Congress and the White House (no matter who has controlled either) have played an ever more political game of tennis with the budgets for Ryan White care and treatment funds, CDC prevention efforts and other elements, while state and territorial AIDS directors have struggled and screamed to be heard above the din of their 50+ colleagues.  Presidents, Senators, and House chairmen have taken turns grandstanding, pointing fingers, and putting their heads in the sand -- and as a result, no one has been held accountable for the worsening problems at ground level.  Worse yet, since the beginning, the swiss-cheese of federal HIV/AIDS policy has been the stage upon which the left and the right have pushed their nonsensical ideological agendas, often stepping over the bodies of the dead and dying to grab the microphone and show their utter disregard for science, public health and civic duty.

    Enough already.  If this election is supposed to be about change or reform, then let's hear it.  And let's really demand it on AIDS, as gays of all political stripes.  Obama or McCain (or both) must be pushed to propose some radical reforms on how the federal government deals with this issue. 

    We need a national HIV/AIDS strategy, with specific goals and targets, driven from the executive branch and ratified by the Congress.  We need a national AIDS director who proposes this policy, carries it out, reports directly to the Secretary of Health and Human Services with budget authority, testifies to Congress, and is held accountable for its results.  No more ceremonial offices on Lafayette Square or in the White House, which have too often served only as a political shop since the beginning.  Real policy responsibilities, on a real timetable, and real accountability.

    And Congress must be held to account as well.  This idea that one or the other is the "better" party on AIDS is now shown for the charade that it is.  The Republicans have been the ones who delivered on funding and reforms far and above the Democrats before or after them, but they've also been playing ideological and religious politics with AIDS since the beginning, from gay-bashing in the early days to ineffective abstinence-only and absurd anti-condom prevention requirements today, at the expense of people's lives.  The Democrats have been long on sweet words and militant political support against discrimination (with the exception of visa policy, in which they failed miserably and were cowards until finally rectifying it this year), but have also been shamelessly provincial on funding formulas and naggingly resistent to now-desperately needed reforms in the system.

    Finally, we need to heed the growing clamor from the CDC and adopt routine HIV testing in every state and territory.  CDC director Julie Gerberding has been crying out in the dark to both her own administration and to Congress on this for too long.  Her agency published recommendations, and then guidelines, years ago which call for making HIV testing with informed consent a routine part of medical care for all Americans aged 13 to 65, but no one is heeding it because she has no authority to mandate it.  All of the science shows that it is the only way to close the gap among that huge number of Americans who are not aware of their status.  Without it, we cannot prevent new infections from this population and we cannot move them into treatment.  Two separate studies, one from Harvard and Yale, the other from Stanford, showed that routine testing would be as cost-effective as blood pressure checks have been.  It's barbaric that we've just sit by and let these new statistics just happen even though we've known for years that routine testing could have helped prevent them.

    In the end, my vote will be much more influenced by whether either candidate shows a real comprehension of the emergency we're facing at the federal level on HIV/AIDS, than by their positions on the apparently comatose ENDA or hate crimes bills.  And not just lovely talk, or great big hugs, but real understanding of the sweeping reform that is necessary.

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    Comments

    1. Lucas on Sep 12, 2008 3:26:39 PM:

      I apologize for my pessimism, but I can see how people would think: Why should we care about a disease that kills a couple of sinful faggots?

      In a political climate where sex education consist of abstinence alone, ignoring other preventive measures, where gay sex is equated with child molestation and rape, where people are passing laws in states, preventing equal protections for gay folks and their loved ones, why would they care to protect a segment of population they clearly deem as second class and sub-human?

    1. Lucrece on Sep 12, 2008 4:09:12 PM:

      Because, despite it majorly affecting the gay demographic, it's also a problem in the black community, particularly women. The black community can shake it quite a bit, as opposed to the toothless gay one.

    1. Peter Staley on Sep 12, 2008 4:26:29 PM:

      Great post. Finally, a gay blogger willing to talk about the rising HIV infection rate among gay men in the U.S. I've posted my own blog entry thanking you for posting this (http://blogs.poz.com/peter/archives/2008/09/finally_a_gay_b.html).

      You hit the head on the nail for the long-overdue need for a national HIV/AIDS strategy.

    1. Peter Staley on Sep 12, 2008 4:29:09 PM:

      woops -- I obviously meant "nail on the head" -- feeling dyslectic today.

    1. D.R. Scott on Sep 13, 2008 2:57:09 PM:

      Honestly, choosing between the two candidates is pretty much a no-brainer at this point. Do you really believe that The Crypt Keeper and the Not Ready For Prime Time Hockey Mom really give a damn about the AIDS crisis? Hell, in their minds I'm sure they think of it as being a just punishment from God.

    1. dwerk on Sep 14, 2008 8:56:17 AM:

      Also, as much as 80% of gay and bisexual men in 15 cities have not been reached by HIV prevention efforts that have been proven effective.

      Interesting quote, Chris. In my city (Toronto), there is almost no prevention for gay men (other than racialized or drug using MSM) -- yet out LBT Centre just got massive funding to discover the HIV prevention needs of FTM trans who identify as "gay" -- when asked what possible info could be different for this group that any available for men or women I was informed that they have a hard time talking about their genitals and have low self esteem so are at risk. That is where we are at today -- gay men = oppressing male privilege who have enough money and power so need no public services; transpeople = victims with nothing who need everything. There's the problem. Trans empowerment is more important in the community share of resources than a bunch of privileged gay men getting infected.

    1. dwerk on Sep 14, 2008 8:57:46 AM:

      Also, as much as 80% of gay and bisexual men in 15 cities have not been reached by HIV prevention efforts that have been proven effective.

      Interesting quote, Chris. In my city (Toronto), there is almost no prevention for gay men (other than racialized or drug using MSM) -- yet out LBT Centre just got massive funding to discover the HIV prevention needs of FTM trans who identify as "gay" -- when asked what possible info could be different for this group that any available for men or women I was informed that they have a hard time talking about their genitals and have low self esteem so are at risk. That is where we are at today -- gay men = oppressing male privilege who have enough money and power so need no public services; transpeople = victims with nothing who need everything. There's the problem. Trans empowerment is more important in the community share of resources than a bunch of privileged gay men getting infected.

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    1. Mark Cohen on Aug 13, 2009 6:23:20 PM:

      I was given my AIDS diagnosis early in 1995 and a prognosis of about a year to live. Since then I have had to rely on systems that reluctantly dole out most of the help I have needed to stay alive. For most of this time I have been a part of a program where positive speakers go into high schools and middle schools to tell their stories as prevention. For most of them, if they ever think about it at all, it is that it seems not so bad if you have to take a pill or two. Perhaps it is partly our own fault for making it look too easy. But anyway, my point actually is that when I ask each class how many of them have ever talked about HIV at home. Almost none have - almost NONE. At least out here in the California Desert, my obvious gayness has become much less of an issue for them because I almost never get questioned about it (which was not true when I first started talking about 12 years ago). Young gay men ARE putting themselves more at risk, I think, because no one in their lives is talking about it. WE NEED TO TALK ABOUT IT MUCH MORE. If we can get them talking about it, then we get them thinking about it and hopefully acting on it. And this is true for all kids (and adults). More of us have to be out there sharing the horrors of what we live with rather then having the public think they can take a pill and then go mountain climbing (I know you have seen the ads)

    1. Cialis Online on Sep 21, 2009 10:21:29 AM:

      hello I suffer of this disease or virus I don't know but I want to know id when I died somebody Remember me?"

    1. Tadalafil Online on Nov 25, 2009 9:40:57 AM:

      ok i know some people have no symptoms or little symptoms when theyhave hiv/aids well...is coughing at night only and not in the day a symptom of having aids/hiv??

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